WHO Recommendation Should Be Critically Discussed

Letters to the Editor Symptoms During Outpatient Cancer Treatment and Options for Their Management by PD Dr. med. Mitra Tewes, PD Dr. sportwiss. Freerk Baumann, Prof. Dr. med. Martin Teufel, and Prof. Dr. med. Christoph Ostgathe in issue 17/2021

We read the article with great interest (1), but we consider that accepting the WHO recommendation on single-fraction radiation therapy for the purpose of efficient resource use without further commentary to be too superficially handled. Of course, the conservation of medical resources is also an important aspect in the German health system, but this recommendation by the WHO does not reflect the treatment and therapy options in a developed industrial country, like Germany. As a result of the further development of systemic therapy options, there is an increasing number of patient collectives who receive palliative care, who have a significantly longer survival times, and who definitely benefit from hypofractionated, local therapy for bone metastases (2, 3). In the context of one-time irradiation, the analgesic effects are equally good, but the rate from re-irradiation is around 20% higher (4).

Particularly in situations in which longer survival is to be expected, the risk of the need for re-irradiation under the one-time concept of course increases, and thus the therapy effort and the therapy costs inevitably increase.

It is therefore the patient‘s specific constellation that determines which radiotherapy can be expected to provide the greatest benefit—both in terms of analgesia and long-term control—in order to avoid re-irradiation if possible. That too has a decisive influence on the quality of life.

DOI: 10.3238/arztebl.m2021.0285

Mathias Sonnhoff
Dipl.-Biol. Mandy Graff
Zentrum für Strahlentherapie Bremen, Germany

Conflict of interest statement:
The authors declare that no conflict of interest exists.

References

1. Tewes M, Baumann F, Teufel M, Ostgathe C: Symptoms during outpatient cancer treatment and options for their management. Dtsch Arztebl Int 2021; 118: 291–7

2. Maity A, Mick R, Huang AC, et al.: A phase I trial of pembrolizumab with hypofractionated radiotherapy in patients with metastatic solid tumours.Br J Cancer 2018; 119: 1200–7

3. Milano MT, Katz AW, Zhang H, et al.: Oligometastatic breast cancer treated with hypofractionated stereotactic radiotherapy: some patients survive longer than a decade. Radiother Oncol 2019; 131: 45–51

4. Peters C, Vandewiele J, Lievens Y, et al.: Adoption of single fraction radiotherapy for uncomplicated bone metastases in a tertiary centre. Clin Transl Radiat Oncol 2021; 27: 64–9